Thursday, November 11, 2010

Pregnancy Loss

**TMI alert-This post includes talk (and pictures) relating to the conditions of the female body I think this kind of stuff is fascinating--I share it for those of you that share the sentiment.)**

Most people don't enter the conception process planning for a pregnancy loss.  I definitely didn't .  My mother had enjoyed excellent fertility--I was the only baby that decided I didn't feel like coming right when they wanted me--but I didn't make Mom and Dad wait too long.

As a married woman of 6 1/2 years I can now say that the majority of women I know personally have suffered a loss.  I believe official numbers say that 1 in 4 confirmed (by a doctor) pregnancies are lost, but it may be as many as 1 in 3 including pregnancies that have not yet been confirmed by a doctor. 

 Many people discount early miscarriages--stating that if it weren't for our super-sensitive modern home pregnancy tests women wouldn't even know they were pregnant and just think they had a "late, heavy period."  Sure that could be some people's experiences, but you have to accept that that isn't always the case.   I am never "late."  By body has cycled like clockwork since menarche, and 42 days is way past 29.  Additionally, "a heavy period" does not accurately describe the type of bleeding and tissue lost, even after only 6 weeks, that comes from an early miscarriage.  I found that passing the "products of conception" was a difficult thing to emotionally go through .

I studied human development in college. I understand the science behind early losses.  The reproductive system is a machine who's purpose is to create new perfect little human bodies.  This machine is intelligent enough to know when something is not going right.  When the process has started and is headed in the direction of creating  something other than a perfect human body--the body frequently aborts the process to start anew with hope of a better outcome next time.

(There can be other problems causing early miscarriages such as hormonal imbalances during the leuteal phase--if you encounter multiple miscarriages please seek the advice of a doctor trained in fertility.)

I feel I have a level-headed view of early loss accepting the biology behind it--but it's still hard on an emotional level.  Because each time you conceive there is an explosion in your mind opening up a great expanse full of infinite new possibilities for the future.   And when you experience a loss that great cavern is instantly and suddenly closed, blackened out.  It's disorienting and confusing.

Six months after my miscarriage I was pregnant again.  (We had allowed my body time to rest and heal for three months as recommended because my body had very definitely been pregnant.  Jeremy, especially, was concerned that I not overtax my body.) I had been visiting my sister and returned to our new apartment and was nauseated by the smell.  Stale cigarette stench coming into our apartment through the bathroom vent, closet, and kitchen piping--courtesy of our neighbors.  Within a week my oversensitive sense of smell was officially attributed to pregnancy.  Once again though, I already knew I was pregnant.  (I won't mention how--it's definitely TMI.)  I took a few tests, because at first it showed negative.  Officially past the date of a not-actually-expected period I finally got a faint-faint line.  I showed it to Jeremy, explaining, "You're either pregnant or not. A faint line is still a line." It was interesting looking back though, to wonder if the test didn't initially pick up the pregnancy because it wasn't developing normally.

At six weeks I started spotting.  It was happening again.  This time on insurance we went in for blood work.  I had blood drawn on cycle days 40 and 43.    My hcg levels were appropriate and doubling. But I still was spotting on and off.  We set an ultrasound for 7 weeks. ( That's usually the earliest they do it since that's when they can consistently find "something" to see on an ultrasound.) I didn't feel well that week. I remember going to a playgroup at the church and then leaving after not too long because I felt poorly.

The weekend before my ultrasound I felt really bad.  I had a lot of cramping and pain.  But I had been on mild bedrest since I began spotting.  I remember that in the hospital after the birth of Owen the nurses had explained that I needed to be up and walking around to help gas (causing cramping) to work itself out of my system.  I thought this may be similar since I'd been sitting around.  I felt like the pain was concentrated more to my right side--but I just felt horrible all over anyway. 

The next day we went in (cycle day 50) for our ultrasound at 11:00am.

The sonographer was very polite. pointed out some things on the sonogram, "There's your ovaries." etc. and then asked me about my pain--if it had been to one side or the other.  Then she said she'd go get out doctor to talk over the results.  She left the room and Jeremy and I just looked at each other.

"So what does that mean?"  Jeremy asked.

"Well she didn't show us a baby." I replied.

"Suspected ectopic pregnancy," our doctor explained.  He showed how my uterus had a thick lining suggesting my body thought it was pregnant.  But then showed us a large mass in my right fallopian tube. No real baby or anything, because in most-cases your body knows that something isn't quite right and won't let the baby develop.  He said his only doubt was that most people are in so much pain.  Well,  I was in pain--but I'm not really the go-to-the-doctor type.  Es specially when I've been reading all the worst-case-scenarios in my pregnancy books and think that I'm fabricating the symptoms like--it hurts worse on my right side.

There's a medicinal option for dealing with an ectopic pregnancy.  Methotrexate.  An anti-cancer drug that attacks growing cells.  My doctor didn't recommend it, saying there are lot's of growing cells in your body that could be adversely affected.  Now that I've met (over the internet) more women who have experienced ectopic pregnancies--I still feel good about my Doctors recommendations.  Some women had to have more courses of the medication because it wasn't enough the first time.  And there comes a point also when it's too late for methotrexate to work at all. 

So an hour and a half later I was in surgery.

Technically it was exploratory surgery to confirm the ectopic pregnancy and treat it.  The goal was to sawe my tube if we could.

This is my left tube and ovary, with my uterus on the right side.  You can see my abdominal cavity was filled with blood.

This is my right tube wrapped around the right ovary.  It's hard to tell since the tube is swollen to the size of my ovary.  The ovary is the paler one.  In the left half of the frame you can see my uterus. 

This is the adhesions that most-likely caused the ectopic pregnancy.  I had no reason to have such adhesions.  No PID, no internal bleeding, or previous abdominal surgeries.  But there is is. 

Here is the pregnancy in my tube.  There is a build-up of blood inside as well.  It wasn't possible to save the tube. 

This picture is after the tube was removed.  You can still see the pale ovary.  The gray-brown backwards "C" between the ovary and the uterus is the cauterized tissue from the removal. 

As for the surgery (technically a laproscopy and salpingectomy) for anyone reading this as a reference, it was general anesthesia.  Then they make two or three incisions mine were: belly button, bikini line, and over that right side.  The fill your abdomen with gas to puff it up so they can have a clear view.  When you wake up there is excess gas that has crept into strange places in your body.  Luckily I had warning of this from a friend who told me the shoulder pain would be very uncomfortable. --it was. And my throat was scratchy from having the anesthesia tube down it.  The pain from the surgery was managed with pain meds.  The only problems were coughing, sneezing, and laughing.  That last one proved the biggest problem because my mom came to help out.  Jeremy and my mom under the same roof--they set records for jokes and laughter. 

My doctor promised internal pinches and twinges for a good six months, and I had them.  I'd have more pain on that side with my period too. 

Happily my fertility has not been too adversely affected.  The right ovary was left behind because technically it could still contribute to my fertility.  Wyatt is proof of that--at my 7 week ultrasound the sonographer saw a happy corpus luteum on my right ovary.  Indicating I'd ovulated from that side and it hade been picked up by my left tube. 

It's been three years now, and I'd say it's mostly forgotten.  It's one of those things you think back on and say "Wow, we did that."  But you just do.  You just deal with the things that life sends your way because none of us get to choose it.  And it does help to remind us all to be sensitive of the struggles of those around us, and that every pregnancy is a miracle.

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